Carcinoidal tumor of the kidney

A Case Report of Carcinoid With Teratoma Arising From the Renal Hilum

Teratoma is a germ cell tumor composed of 2 or 3 germ cell layers, and it can occur in various parts of the human body. However, teratomas of the renal hilum are particularly rare, and those complicated by carcinoids are even more uncommon. Herein, we report the example of an asymptomatic 49-year-old woman in whom a tumor in the right renal hilum was unexpectedly discovered on imaging. Histological examination revealed a carcinoid tumor arising from a simple cyst composed of teratomatous tissue. Although the tumor was located in the renal hilum and touched the renal parenchyma, it appeared independent of the kidney and urinary tract. This report highlights the rare occurrence of teratomas with carcinoids and provides insights into their origins.

Primary renal neuroendocrine neoplasms: A systematic literature review, report of four local cases, and original survival analysis of 63 patients from a national registry 2012-2018

Primary renal neuroendocrine neoplasms (NEN) are rare. We aimed to conduct a systematic review, present local cases, and analyse data from the England's National Cancer Registration and Analysis Service (NCRAS) to provide comprehensive evidence on clinical experience, incidence, and survival to better characterize these tumours. First, a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method; second, a synthesis of local cases; and, finally, a retrospective population-based cohort analysis of renal NEN recorded between 2012 and 2018 on NCRAS were performed. Kaplan-Meier estimator was used to calculate overall survival and Cox proportional hazard regression to identify prognostic factors. Systematic review identified 48 articles and the evidence was summarized and presented. We reported data from four local cases presenting with abdominal and back pain but without carcinoid syndrome. In population-based analysis, we identified 63 cases of renal NEN between 2012 and 2018 from the registry. Age-standardized incidence was 0.09-0.32 per million with a median age of 64 years (interquartile range = 48-72 years). Survival was worse in males and those aged 64 years and over. Five-year survival for renal neuroendocrine tumours (NET) was 69.8% (95% confidence interval = 66.6-72.7) and neuroendocrine carcinomas (NEC) was 38.4% (95% confidence interval = 34.6-42.0). No independent predictive factor was identified in the multivariable analyses. We have given a systematic review of evidence, published local experience, and reported incidence and survival of renal NEN in England for the first time. We have provided clinicians with evidence on diagnosis and proposed a treatment algorithm of theses rare tumours. The incidence and median age of presentation in England is similar to other published series. Renal NET has better survival than renal NEC as expected. A uniform classification system would reduce inconsistencies in reporting and standardize treatment decisions for this neoplasia.

An infertile female delivered a baby after removal of primary renal carcinoid tumor

Primary renal carcinoid tumors are exceedingly rare. We report a 37-year-old woman with primary infertility, who was found to have a primary renal carcinoid tumor. She became pregnant and gave birth to a baby after removal of the tumor. This is the first case in the English literature of primary renal carcinoid tumor related with primary infertility.

Successful Repeated Peptide Receptor Radionuclide Therapies in Renal Neuroendocrine Tumor With Osseous Metastasis

Renal neuroendocrine tumor (NET) is an extremely rarely occurring disease. The sporadic reports in the literature are mostly case reports, or less commonly small studies. In cases of metastatic disease from renal NET, there are no established therapies. We are reporting our experience with a patient with extensive osseous infiltration of a renal NET, who was successfully treated with peptide receptor radionuclide therapy (PRRT) using Lu-DOTATATE. In a period of 10 years, the patient underwent in total 12 cycles of PRRT with a cumulative dose of 81 GBq. All therapies were unproblematic and well tolerated.

Primary Carcinoid Tumor of the Renal Pelvis Arising From Intestinal Metaplasia: An Unusual Histogenetic Pathway?

OBJECTIVES

Primary carcinoid tumor of the renal pelvis is a rare neoplasm with few cases reported in the literature. Here we present the clinical and histopathologic findings of a primary carcinoid tumor arising in the left renal pelvis of a horseshoe kidney in a 61-year-old female patient.

MATERIALS AND METHODS

Pathologic features were evaluated with standard hematoxylin and eosin sections and immunohistochemical studies. A literature review was performed to place our case in context to previous reports.

RESULTS

The tumor was associated with intestinal metaplasia with high-grade dysplasia and neuroendocrine hyperplasia. Molecular testing for microsatellite instability and loss of heterozygosity were negative.

CONCLUSIONS

This report portrays a unique presentation of carcinoid tumor arising from intestinal metaplasia of the pelvic urothelium, and supports its histogenesis from urothelial intestinal metaplasia and neuroendocrine hyperplasia.

[A case of renal carcinoid with local recurrence and multiple lymph node metastases 4 years after partial nephrectomy]

Primary renal carcinoid is an uncommon tumor. We report a case of local recurrence and multiple lymph node metastases of renal carcinoid 4 years after partial nephrectomy in a 64-year-old man. He was incidentally found to have a mass lesion in the right kidney and right partial nephrectomy was performed 4 years ago. Histological examination including immunohistochemical studies confirmed the diagnosis of the atypical primary renal carcinoid. After 4 years of follow up, abdominal ultrasonography and computed tomography demonstrated a local recurrence and multiple lymph node metastases around the inferior vena cava. He underwent right radical nephrectomy with paraaortic and right renal hilum lymphadenectomy. Histological appearance showed that recurrence of the atypical renal carcinoid. Four of the resected five lymph nodes were positive for metastasis. Unexpectedly, two tiny renal cell carcinomas were also found from the right kidney. The patient remains free from disease recurrence for 2 months post re-operation. This case is the 43rd report of renal carcinoid tumor in Japan.

Primary Carcinoid Tumors of the Kidney

PURPOSE

We describe in detail the features of carcinoid tumors of the kidney. We evaluated possible prognostic factors.

MATERIALS AND METHODS

An extensive search was performed in the medical literature regarding primary carcinoid tumors of the kidney. Epidemiological, clinical, diagnostic, histopathological, therapeutic and prognostic data were evaluated. Several potential risk factors were compared with the incidence of metastases and clinical outcome of the patients.

RESULTS

A total of 56 case reports were reviewed. Median patient age was 49 years. Horseshoe kidneys were present in 17.8% of cases. Incidental diagnosis was made in 28.6% of patients. The most common symptom was abdominal or flank pain and neuroendocrine syndromes occurred with only 12.7% of primary renal carcinoid tumors. Of the patients 73.6% presented with tumors larger than 4 cm. Metastases were present in 45.6% of patients at initial diagnosis and almost 60% with tumors greater than 4 cm had metastases.

CONCLUSIONS

Renal carcinoid is the second most prevalent genitourinary carcinoid in each sex, following testicular carcinoids in men and ovarian tumors in women. Significant adverse prognostic factors include age greater than 40 years, tumor size greater than 4 cm, purely solid tumors on the cut surface, mitotic rate higher than 1/10 high power fields, metastasis at initial diagnosis and tumors extending throughout the renal capsule.

Carcinoid tumors of the urinary tract and prostate

CONTEXT

Carcinoid tumors are exceedingly rare in the genitourinary tract and may occur in the kidney, urinary bladder, urethra, or prostate.

OBJECTIVE

To review the clinical and pathologic features of carcinoid tumors occurring in the urinary tract and prostate.

DATA SOURCES

We searched the English language literature using MEDLINE and Ovid.

CONCLUSIONS

Carcinoid tumors of the urinary tract and prostate share similar morphologic features with their counterparts in other organs. The differential diagnosis includes metastatic carcinoid tumor, paraganglioma, and nested variants of urothelial and prostatic carcinomas. Correlation of the clinical presentation and histopathologic features (including the immunohistochemical profile) will ensure accurate diagnosis of these rare tumors.

An unusual coincidence of multiple synchronous kidney tumors with a metachronous rectal adenocarcinoma

In synchronous surgery specimens (right-sided nephrectomy and left-sided partial nephrectomy), a unique combination of a papillary (chromophil) renal cell carcinoma (4 x 3.7 x 3.5 cm) and a renal oncocytoma (11 x 10 x 9 mm) in the right kidney and a renal carcinoid (2.5 x 2.3 x 1.1 cm) in the resected part of the left kidney has been found. This multiplicity and bilaterality, based on the findings of three distinct histogenetic types of kidney tumors, was accompanied by a metachronous rectal adenocarcinoma discovered 14 months later. After surgery, no radiation or other oncologic therapy was given. At present, our patient is well without any evidence of neoplastic disease three years after primary diagnosis. To the best of our knowledge, this is the first case of a combination of three distinct histogenetic types of synchronous renal tumors associated with a metachronous rectal adenocarcinoma treated with simple surgery. In the absence of cytogenetic studies, the possibility of a the presence of a hereditary renal cancer syndrome must be considered.

Primary carcinoid tumor in a polycystic kidney

A case of a primary carcinoid tumor within a polycystic kidney is reported. A 51-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) underwent a bilateral nephrectomy because of an infection in her polycystic kidneys. A tumor (1.5 cm in diameter) was incidentally found close to the hilum of the left kidney. Histologically, the tumor exhibited a predominantly trabecular pattern of cuboidal or columnar cells. Grimelius staining showed numerous silver-stained neurosecretory granules in most of the tumor cells; the tumor cells were also positive for chromogranin, synaptophysin, prostatic acid phosphatase (PAP) and neuron-specific enolase (NSE). The tumor was diagnosed as a primary carcinoid tumor of the kidney. Primary renal carcinoid is a very rare neoplasm, and this is the first report of such a lesion arising in a polycystic kidney.

Searching for an intrinsic neuroendocrine cell in the kidney. An immunohistochemical study of the fetal, infantile and adult kidney

The pathogenesis of primary renal carcinoid tumor is unknown. One hypothesis has implied derivation from a yet unrecognized intrinsic neuroendocrine cell in the renal parenchyma/hilum either as a minute endocrineparacrine constituent or resulting from entrapped/misplaced progenitor cells of the so-called dispersed neuroendocrine system during organogenesis. Immunohistochemical staining for chromogranin and serotonin was systematically performed on a whole-mount and geographically mapped normal adult kidney, kidneys from 15 fetuses (age range: 15 to 38 weeks), and renal specimens from 18 infants/children (age range: 7 days to 123 months). Minute paraganglion nests (composed of chromogranin positive/serotonin negative chief cells and S-100 protein positive dendritic cells) were incidentally detected within the renal hilum primitive stroma (unilaterally) of two fetuses at 22 and 26 weeks. Sequestration and persistence of such paraganglion nests during renal growth and maturation would offer a basis for the rare occurrence of extra-adrenal paraganglioma involving the renal hilum/pedicle. Otherwise, no neuroendocrine cell was detected within the renal parenchyma or hilum, therefore not validating/sustaining the aforementioned hypothesis in the pathogenesis of renal carcinoid tumor.

Carcinoid tumor of the kidney. The use of somatostatin receptor scintigraphy in diagnosis and management

Three patients were diagnosed with carcinoid tumors of the kidney. The diagnosis was rendered after biopsy with the assistance of immunohistochemical stains. In all three patients, a pentetreotide scan was helpful in staging. Metastatic disease that was not evident by computed tomography was found in one patient. All three patients are alive with stable or slowly progressive disease at 33, 36, and 40 months. Carcinoid tumors arising from the kidney are rare but must be considered in the differential diagnosis of a renal mass. Immunohistochemical staining is important in the diagnosis of these tumors and the pentetreotide scan contributes to accurate staging.

Renal carcinoid and horseshoe kidney: a frequent association of two rare entities--a case report and review of the literature

We report the case of a primary renal carcinoid tumor associated with a horseshoe malformation in a 43-year-old man who presented with testicular pain. The tumor was centrally located and purely solid and had features ascribed to hindgut neuroendocrine neoplasia. The relative risk of developing a carcinoid tumor in a horseshoe kidney is estimated to be x82.

Primary carcinoid tumour with ossification masquerading as calyx stone in a horseshoe kidney

A case of renal carcinoid tumour arising within a teratoma in a horseshoe kidney in a 23-year-old male is reported. The presenting symptom was abdominal pain, and bone tissue within the tumour was initially misinterpreted as a calyx stone, leading to unsuccessful attempts at extracorporeal shock-wave lithotripsia and percutaneous lithotripsia. This unusual tumour is over-represented in patients with horseshoe kidney and other congenital developmental renal defects.

A primary carcinoid tumor of the kidney: a case report and review of the literature

BACKGROUND

Primary carcinoids are found mostly in the gastrointestinal tract. Primary carcinoid tumor of the kidney is rare; only 28 patients have been reported. Because of the rarity of the lesion, its radiological and clinicopathological features are not well characterized. At the same time, its prognosis and histogenesis is unknown.

METHODS

A 62-year-old patient presented with a carcinoid tumor on the isthmus of the horseshoe kidney. Radiological, clinicopathological, and immunohistochemical tests were performed. The tumor was resected.

RESULTS

Two years later, metastasis were observed in the liver. The metastasis were treated with percutaneous ethanol sclerotherapy (PET).

CONCLUSIONS

To our knowledge, this is the first case of primary renal carcinoid tumor present on the isthmus of the horseshoe kidney and the first case of carcinoid liver metastasis to be treated with PET.

Primary carcinoid of the kidney. Immunohistochemical and ultrastructural studies of five patients

BACKGROUND

Primary carcinoid tumor of the kidney is rare; only 18 patients have been reported. Because of the rarity of the lesion, its prognosis and clinicopathologic features are not well characterized, and its histogenesis is unknown.

METHODS

Clinicopathologic, immunohistochemical, and ultrastructural studies were performed on five patients with primary carcinoid tumor of the kidney.

RESULTS

Age of the patients ranged from 42 to 63 years, with a mean of 53.2 years. Only one patient had a carcinoid syndrome. Three were men, and two were women. In each patient, the tumor was solitary and confined to the kidney. All tumors had histologic features identical to those of carcinoid tumors affecting other sites. The cytoplasmic granules of the tumor cells were reactive with Grimelius stain in all patients. All tumors also were immunoreactive for keratin, neuron-specific enolase, and chromogranin, but only two patients had tumors that reacted for serotonin, pancreatic polypeptide, and vasoactive intestinal polypeptide. Ultrastructural studies showed numerous intracytoplasmic neuroendocrine granules in four tumors. One patient had Robson Stage I cancer, and two each had Stage II and IV cancer. The two patients with Stage IV tumor died of disease at 36 months and 28 months after diagnosis; one patient with Stage II carcinoid is alive without clinical evidence of residual disease 8 years after control of metastases; the other patient with Stage II and the patient with Stage I cancer are alive and well without evidence of disease at 36 months, and 2 months, respectively.

CONCLUSION

Tumor stage at presentation appears to be the most important factor in determining outcome. The number of mitoses and degree of cellular atypia appear to be important pathologic parameters in predicting prognosis, despite the limited number of patients reported in this report.

Primary renal carcinoid tumor

We report a case of primary renal carcinoid tumor. Only 13 prior cases are documented in the literature. The tumor fulfilled both histologic and immunochemical criteria for carcinoid. In addition, we employed new diagnostic modalities (i.e., magnetic resonance imaging and chromogranin-A levels) not used in prior published reports. A review of the literature is presented.

Metastatic carcinoid tumour: stability throughout pregnancy

A patient with asymptomatic histologically proven extensive hepatic metastases of carcinoid tumour had no progression of disease for over 4 years without specific treatment. Throughout a normal pregnancy the hepatic metastases remained stable by clinical, computerized tomography and biochemical criteria.

Carcinoid tumor of the kidney with morphologic and immunohistochemical profile of a hindgut endocrine tumor: report of a case

A 54-year-old man underwent a radical nephrectomy for a presumed renal cell carcinoma. The tumor was large, showed areas of cystic degeneration and calcification, and had completely obliterated the normal renal parenchyma. The light microscopic appearance was atypical for renal cell carcinoma, and when electron microscopy revealed innumerable neurosecretory granules a diagnosis of carcinoid tumor was made. The tumor cells were argentaffin- and argyrophil-negative but were chromogranin-, neuron-specific enolase-, and leu-7-positive. When tested with a battery of antibodies against specific polypeptide hormones, the tumor exhibited diffuse pancreatic polypeptide and focal somatostatin immunoreactivity. Our case represents only the 16th case of carcinoid tumor of the kidney to be reported and the first with demonstrated pancreatic polypeptide immunoreactivity. The predominantly trabecular histology, nonreactivity with silver stains, and immunohistochemical profile of this case are common characteristics of hindgut carcinoids, suggesting that, like rectal carcinoids, renal carcinoids are tumors of hindgut endocrine cells.

Primary renal carcinoid--case report

Carcinoid tumour is a rare cause of a renal mass. Only fourteen cases have been reported since it was first described in 1966. This case illustrates most of the commoner features.

Primary renal carcinoid tumor

A case of primary renal carcinoid tumor in a sixty-seven-year-old man is presented. Radical nephrectomy removed the primary disease, but hepatic metastases developed and the patient subsequently died. Review of the literature disclosed 8 other cases of primary renal carcinoid. Three of these had metastatic spread.

Primary carcinoid tumor of kidney. Light and electron microscopy, and immunohistochemical study

We present a case of primary renal carcinoid tumor with the appearance of type B carcinoid with trabecular and ribbon-like structure. All the immunohistochemical stains were negative. Electron microscopy revealed numerous cytoplasmic granules with polar distribution and masses of intermediate microfilaments. We believe only 8 cases have been reported in the literature.

Oncocytic carcinoid of the kidney associated with periodic Cushing's syndrome

An oncocytic carcinoid of the kidney producing a periodic Cushing's syndrome in an adolescent is described. The tumor displayed gross, histologic, and ultrastructural features similar to renal oncocytoma, another unusual renal neoplasm. A review of renal carcinoids and possible associations between oncocytic change and periodic hormone production are discussed.

Argyrophilic and hormone immunoreactive cells in normal and hyperplastic pancreatic ducts and exocrine pancreatic carcinoma

Scattered argyrophil cells were present in normal, large, medium-sized and small pancreatic ducts (ductules). There was marked increase in argyrophil cells in ducts with hyperplastic epithelium. Argyrophil cells were also found in 67.7% of all exocrine pancreatic carcinomas. In a well differentiated group including cystadenocarcinoma, mucinous carcinoma and well differentiated ductal adenocarcinoma argyrophil cells were found in all cases examined. Using four antisera (against insulin, glucagon, somatostatin and gastrin), insulin, glucagon and somatostatin cells were identified in 2.65%, 0.001% and 1.2% of normal ducts, and 7.5%, 2.4% and 4.6% of ducts with hyperplastic epithelium respectively and were also greatly increased in numbers in the latter group. Immunoreactive cells were present in 66.7% of exocrine carcinomas. Cells reactive for insulin were found in 7/15 cases; glucagon in 6/15 cases; somatostatin in 5/15 cases and gastrin in 2/15 cases. Eight cases contained two or more than two types of immunoreactive cells. The presence of argyrophil and hormone immunoreactive cells in pancreatic ducts and carcinomas is indicative of the close developmental relationship between endocrine and exocrine parts of the pancreas. The inter-relationship of response in the different cell types following stimulus suggests that injury to a common precursor may be involved.

Renal cell carcinoma in pregnancy

Renal cell carcinoma is the most common renal neoplasm associated with pregnancy. The most common presenting symptoms are pain and a palpable mass. Although renal neoplasms in pregnancy are rare, the pregnancy demands special consideration in the methods of diagnostic evaluation. The relationship between renal cell carcinoma and pregnancy is unclear. Treatment is usually radical nephrectomy regardless of the stage of pregnancy. Two new cases are presented with a review of the literature.

Primary carcinoid tumor of the kidney: a light and electron microscopic, and immunohistochemical study

We report a case of primary carcinoid of the kidney. The neoplasm had a trabecular growth pattern and was argyrophil positive and argentaffin negative. An extensive battery of immunohistochemical stains was negative for specific peptide products and keratin. Electron microscopy disclosed numerous cytoplasmic membrane-bound electron-dense core secretory granules and masses of intermediate microfilaments. A review of the pertinent medical literature revealed 5 previously reported cases.